- CenterWell (Richmond, VA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Elevance Health (Richmond, VA)
- **Title: Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Elevance Health (Richmond, VA)
- **Medical Management Nurse ** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... members in different states; therefore, Multi-State Licensure will be required.** The **Medical Management Nurse ** is responsible for review of the most complex… more
- CVS Health (Richmond, VA)
- …Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management , Community Resources ... team will review prior claims to address potential impact on current case management and eligibility status. Assessments and/or questionnaires are designed to use a… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- Summary Registered Nurse - Float Pool Demonstrates integration of biopsychosocial concepts, cognitive skills, and technically competent practice while providing care ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …the EDRP application. Former EDRP participants ineligible to apply. Responsibilities Registered Nurse - Inpatient Spinal Cord The Inpatient Staff Registered Nurse ... nursing practice and determines the appropriate delegation of tasks consistent with the nurse 's obligation to provide optimal care. The focus is on individual growth… more
- ChenMed (Richmond, VA)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- HCA Healthcare (Richmond, VA)
- …of RN experience in a hospital setting preferred. + Previous case management or utilization review experience preferred. Johnston-Willis Hospital has provided ... opportunity to make a real impact. As a **Registered Nurse RN Case Manager** you can be a part...location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential… more
- ChenMed (Richmond, VA)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- Bon Secours Mercy Health (Petersburg, VA)
- …night shift/12hr shifts** **Summary of Primary Functions** The Critical Care Registered Nurse (RN) provides, coordinates, plans, and evaluates the care of the ... life supporting technology/modalities may include but not limited to: ventilator management , CRRT, IABP, Impella, ECMO * Performs hemodynamic monitoring * Clinically… more
- ChenMed (Colonial Heights, VA)
- …informed decisions re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and reimbursement for ... of the plan of care, health education, specialty referrals, case management referrals, follow-up and clear documentation according to ChenMed standards for… more
- Elevance Health (Richmond, VA)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... **Transplant Nurse II** **Location:** Virtual: This role enables associates...II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn… more
- Intermountain Health (Richmond, VA)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Evolent (Richmond, VA)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Elevance Health (Richmond, VA)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Richmond, VA)
- …to 8:00 PM EST. The ** Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by ... ** Nurse Case Manager II** **Location:** This role enables...providers, claims or service issues. Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Humana (Richmond, VA)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals... 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- …(ACE) Program** **is a 12-week program designed specifically to support the new-to-practice Nurse in preparation for a RN bedside role. ACE will help you find ... being alone. The continuing education and the ability to work with an experienced nurse provides you with confidence to ask questions, an ability to admit the things… more
- Bon Secours Mercy Health (Richmond, VA)
- …clinicians are recognized for clinical and operational excellence. Job Description **Registered Nurse (RN) - FT - Orthopedic Operating Room - St. Mary's Hospital** ... partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, relationship-based… more